Unit of Infections and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, Av. Gran Via 199-203, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
Eur J Cancer. 2010 Nov;46(16):2973-85. doi: 10.1016/j.ejca.2010.06.016. Epub 2010 Jul 16.
In Spain, prophylactic vaccination against human papillomavirus (HPV) types 16 and 18 is being offered free-of-charge to one birth cohort of girls aged 11-14. Screening is opportunistic (annual/biannual) contributing to social and geographical disparities.
A multi-HPV-type microsimulation model was calibrated to epidemiologic data from Spain utilising likelihood-based methods to assess the health and economic impact of adding HPV vaccination to cervical cancer screening. Strategies included (1) screening alone of women over age 25, varying frequency (every 1-5 years) and test (cytology, HPV DNA testing); (2) HPV vaccination of 11-year-old girls combined with screening. Outcomes included lifetime cancer risk, life expectancy, lifetime costs, number of clinical procedures and incremental cost-effectiveness ratios.
After the introduction of HPV vaccination, screening will need to continue, and strategies that incorporated HPV testing are more effective and cost-effective than those with cytology alone. For vaccinated girls, 5-year organised cytology with HPV testing as triage from ages 30 to 65 costs 24,350€ per year of life saved (YLS), assuming life-long vaccine immunity against HPV-16/18 by 3 doses with 90% coverage. Unvaccinated girls would benefit from organised cytology screening with HPV testing as triage; 5-year screening from ages 30 to 65 costs 16,060€/YLS and 4-year screening from ages 30 to 85 costs 38,250€/YLS. Interventions would be cost-effective depending on the cost-effectiveness threshold and the vaccine price.
In Spain, inequitable coverage and overuse of cytology make screening programmes inefficient. If high vaccination coverage among pre-adolescent girls is achieved, organised cytology screening with HPV triage starting at ages 30 to at least 65 every 4-5 years represents the best balance between costs and benefits.
在西班牙，正在为一个年龄在 11-14 岁的女孩出生队列免费提供针对人乳头瘤病毒（HPV）类型 16 和 18 的预防性疫苗接种。筛查是机会性的（每年/每两年一次），导致了社会和地理差异。
使用基于似然的方法，使用多 HPV 型微模拟模型对来自西班牙的流行病学数据进行校准，以评估将 HPV 疫苗接种添加到宫颈癌筛查中的健康和经济影响。策略包括：（1）仅对 25 岁以上的妇女进行筛查，筛查频率（每 1-5 年一次）和检测（细胞学、HPV DNA 检测）不同；（2）对 11 岁女孩进行 HPV 疫苗接种并结合筛查。结果包括终生癌症风险、预期寿命、终生成本、临床程序数量和增量成本效益比。
在引入 HPV 疫苗接种后，仍需要继续进行筛查，并且包含 HPV 检测的策略比仅使用细胞学检测更有效和更具成本效益。对于接种疫苗的女孩，假设通过 3 剂接种疫苗实现 HPV-16/18 的终身疫苗免疫力，覆盖率为 90%，则每挽救 1 年生命（YLS）的 5 年有组织细胞学检查和 HPV 检测作为 30 岁至 65 岁的分流成本为 24350 欧元。未接种疫苗的女孩将受益于组织细胞学筛查和 HPV 检测作为分流；从 30 岁到 65 岁的 5 年筛查费用为 16060 欧元/YLS，从 30 岁到 85 岁的 4 年筛查费用为 38250 欧元/YLS。干预措施将具有成本效益，具体取决于成本效益阈值和疫苗价格。
在西班牙，覆盖范围不均和细胞学过度使用使筛查计划效率低下。如果在青春期前女孩中实现了高疫苗接种率，那么从 30 岁开始至少到 65 岁每 4-5 年进行一次有组织的细胞学筛查和 HPV 分流代表了成本效益之间的最佳平衡。
